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Apaydin Z, Demir R, Mustafaoglu R, Sinan UY, Arabaci HO, Kucukoglu MS. Evaluation of upper extremity functional capacity and activities of daily living in patients with heart failure: A cross-sectional study. Heart Lung 2024; 68:316-322. [PMID: 39216179 DOI: 10.1016/j.hrtlng.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Considering the limitations in activities of daily living (ADL) and the impact of improvements in patients with heart failure (HF), appropriate assessment of upper extremity functional capacity and ADL is important. OBJECTIVES To evaluate upper extremity functional capacity and ADL in patients with HF and compare them with healthy controls. METHODS This study included 30 HF patients and healthy controls. Upper extremity functional capacity was assessed with the 6-Minute Pegboard Ring Test (6PBRT), ADL by the Londrina protocol, exercise capacity by 6-Minute Walk Test (6MWT), peripheral muscle strength by hand dynamometer, and dyspnea by Modified Medical Research Council Scale (MMRC). For performance tests, pre-test (resting) and post-test (after performance) values were also measured. RESULTS Patients with HF with ejection fraction ≤50 % and controls were similar in terms of age (52.63±6.2 and 50.03±6.5 years, respectively) and gender (25 females for each group) (p > 0.05). Patients showed a statistically significant increase in total test time in the Londrina protocol and fewer rings moved in 6PBRT (p < 0.0001). The post-test dyspnea (p = 0.03) and pre-test arm fatigue (p < 0.0001) were observed to be higher in patients in the Londrina protocol. There was a statistically significant group by time interaction in the patients' pre- and post-test lower heart rate (F= 4.80, p = 0.03), post-test dyspnea (p < 0.0001), and post-test arm fatigue (p = 0.005) were observed to be higher in patients in 6PBRT. CONCLUSIONS The evidence showed a decrease in upper extremity functional capacity in patients with HF. Patients required more time to perform their ADLs compared with healthy controls.
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Affiliation(s)
- Zelal Apaydin
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey; Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Yeni Yuzyil University, Istanbul, Turkey
| | - Rengin Demir
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Haseki St., 34096, Istanbul, Turkey.
| | - Rustem Mustafaoglu
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Umit Yasar Sinan
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Haseki St., 34096, Istanbul, Turkey
| | - Hidayet Ozan Arabaci
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Haseki St., 34096, Istanbul, Turkey
| | - Mehmet Serdar Kucukoglu
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Haseki St., 34096, Istanbul, Turkey
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Hoxha I, Guda B, Hoti A, Zhubi E, Selmani E, Avdiu B, Cegllar J, Marušič D, Osmani A. Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14638. [PMID: 36429362 PMCID: PMC9690698 DOI: 10.3390/ijerph192214638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Heart failure represents a life-threatening progressive condition. Early diagnosis and adherence to clinical guidelines are associated with improved outcomes for patients with heart failure. However, adherence to clinical guidelines remains limited in Kosovo. OBJECTIVE To assess the clinical decision-making related to heart failure diagnosis by evaluating clinicians' preferences for clinical attributes. METHOD Conjoint analysis with 33 clinical scenarios with physicians employed in public hospitals in Kosovo. SETTING Two public hospitals in Kosovo that benefited from quality improvement intervention. PARTICIPANTS 14 physicians (internists and cardiologists) in two hospitals in Kosovo. OUTCOME MEASURES The primary outcome was the overall effect of clinical attributes on the decision for heart failure diagnosis. RESULTS When considering clinical signs, the likelihood of a heart failure diagnosis increased for ages between 60 to 69 years old (RRR, 1.88; CI 95%, 1.05-3.34) and a stable heart rate (RRR, 1.93; CI 95%, 1.05-3.55) and decreased for the presence of edema (RRR, 0.23; CI 95%, 0.15-0.36), orthopnea (RRR, 0.31; CI 95%, 0.20-0.48), and unusual fatigue (RRR, 0.61; CI 95%, 0.39-0.94). When considering clinical examination findings, the likelihood for heart failure diagnosis decreased for high jugular venous pressure (RRR, 0.49; CI 95%, 0.32-0.76), pleural effusion (RRR, 0.35; CI 95%, 0.23-0.54), hearing third heart sound, (RRR, 0.50; CI 95%, 0.33-0.77), heart murmur (RRR, 0.57; CI 95%, 0.37-0.88), troponin levels (RRR, 0.59; CI 95%, 0.38-0.91), and NTproBNP levels (RRR, 0.36; CI 95%, 0.24-0.56). CONCLUSIONS We often found odd and wide variations of clinical signs and examination results influencing the decision to diagnose a person with heart failure. It will be important to explore and understand these results better. The study findings are important for existing quality improvement support efforts and contribute to the standardization of clinical decision-making in the public hospitals in the country. This experience and this study can provide valuable impetus for further examination of these efforts and informing policy and development efforts in the standardization of care in the country.
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Affiliation(s)
- Ilir Hoxha
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
- Evidence Synthesis Group, 10000 Prishtina, Kosovo
- Research Unit, Heimerer College, 10000 Prishtina, Kosovo
- Lux Development, 10000 Prishtina, Kosovo
| | - Besim Guda
- General Hospital of Gjilan, 60000 Gjilan, Kosovo
| | - Ali Hoti
- General Hospital of Prizren, 20000 Prizren, Kosovo
| | - Esra Zhubi
- Evidence Synthesis Group, 10000 Prishtina, Kosovo
| | - Erza Selmani
- Evidence Synthesis Group, 10000 Prishtina, Kosovo
- Research Unit, Heimerer College, 10000 Prishtina, Kosovo
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Nohria A, Drazner MH. Should weight loss be targeted during an acute heart failure admission? J Card Fail 2022; 28:1125-1127. [PMID: 35114385 DOI: 10.1016/j.cardfail.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Anju Nohria
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
| | - Mark H Drazner
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
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Chiem AT, Lim GW, Tabibnia AP, Takemoto AS, Weingrow DM, Shibata JE. Feasibility of patient-performed lung ultrasound self-exams (Patient-PLUS) as a potential approach to telemedicine in heart failure. ESC Heart Fail 2021; 8:3997-4006. [PMID: 34288549 PMCID: PMC8497224 DOI: 10.1002/ehf2.13493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/23/2021] [Accepted: 06/12/2021] [Indexed: 01/14/2023] Open
Abstract
Aims Patient‐performed lung ultrasound (LUS) in a heart failure (HF) telemedicine model may be used to monitor worsening pulmonary oedema and to titrate therapy, potentially reducing HF admission. The aim of the study was to assess the feasibility of training HF patients to perform a LUS self‐exam in a telemedicine model. Methods and results A pilot study was conducted at a public hospital involving subjects with a history of HF. After a 15 min training session involving a tutorial video, subjects performed a four‐zone LUS using a handheld ultrasound. Exams were saved on a remote server and independently reviewed by two LUS experts. Studies were determined interpretable according to a strict definition: the presence of an intercostal space, and the presence of A‐lines, B‐lines, or both. Subjects also answered a questionnaire to gather feedback and assess self‐efficacy. The median age of 44 subjects was 53 years (range, 36–64). Thirty (68%) were male. Last educational level attained was high school or below for 31 subjects (70%), and one‐third used Spanish as their preferred language. One hundred fifty of 175 lung zones (85%) were interpretable, with expert agreement of 87% and a kappa of 0.49. 98% of subjects reported that they could perform this LUS self‐exam at home. Conclusions This pilot study reports that training HF patients to perform a LUS self‐exam is feasible, with reported high self‐efficacy. This supports further investigation into a telemedicine model using LUS to reduce emergency department visits and hospitalizations associated with HF.
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Affiliation(s)
- Alan T Chiem
- Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive North Annex, Sylmar, Los Angeles, California, 91342, USA
| | - George W Lim
- Emergency Medicine and Anesthesiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Amir P Tabibnia
- Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive North Annex, Sylmar, Los Angeles, California, 91342, USA
| | - Andrea S Takemoto
- Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive North Annex, Sylmar, Los Angeles, California, 91342, USA
| | - Daniel M Weingrow
- Emergency Medicine, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Jacqueline E Shibata
- Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive North Annex, Sylmar, Los Angeles, California, 91342, USA
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Maezawa S, Kudo D, Miyagawa N, Yamanouchi S, Kushimoto S. Association of Body Weight Change and Fluid Balance With Extubation Failure in Intensive Care Unit Patients: A Single-Center Observational Study. J Intensive Care Med 2019; 36:175-181. [PMID: 31726914 DOI: 10.1177/0885066619887694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To elucidate whether fluid balance and body weight change are associated with failed planned extubation. MATERIALS AND METHODS Patients who received invasive mechanical ventilation for over 24 hours were enrolled and divided into extubation success and extubation failure groups. Fluid balance and body weight fluctuation within 24 and 48 hours before extubation and from admission to planned extubation were calculated. The primary outcome was extubation failure (ie, all-cause reintubation within 72 hours). The association of extubation failure with fluid balance and body weight change was assessed via logistic regression analysis. RESULTS Extubation failure occurred in 12(7.4%)/161 patients. The extubation success group had a significantly lower fluid balance within 24 hours before extubation than did the extubation failure group (-276 mL [-1111 to 456] vs 1217 mL [503 to 1875], P = .002). However, fluid balance within 48 hours before extubation, cumulative fluid balance, and body weight change were not significantly different between the 2 groups. The sensitivity and specificity of water balance +1000 mL within 24 hours before extubation for the extubation failure group were 0.54 and 0.84, respectively, based on the receiver operating characteristic curve. Logistic regression analysis showed that fluid balance within 24 hours before extubation was associated with extubation failure (odds ratio: 22.9, 95% confidence interval: 4.1-128.4). CONCLUSIONS A larger fluid balance within 24 hours before extubation is associated with extubation failure. Thus, fluid balance may be a good indicator of extubation outcome.
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Affiliation(s)
- Shota Maezawa
- Department of Emergency and Critical Care, Tohoku University Hospital, Aoba-ku, Sendai, Japan.,Department of Emergency and Critical Care, 73692Osaki Citizen Hospital, Osaki, Japan
| | - Daisuke Kudo
- Department of Emergency and Critical Care, Tohoku University Hospital, Aoba-ku, Sendai, Japan.,Division of Emergency and Critical Care Medicine, Graduate School of Medicine, Tohoku University, Aoba-ku, Sendai, Japan
| | - Noriko Miyagawa
- Department of Emergency and Critical Care, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Satoshi Yamanouchi
- Department of Emergency and Critical Care, 73692Osaki Citizen Hospital, Osaki, Japan.,Division of Emergency and Critical Care Medicine, Graduate School of Medicine, Tohoku University, Aoba-ku, Sendai, Japan
| | - Shigeki Kushimoto
- Department of Emergency and Critical Care, Tohoku University Hospital, Aoba-ku, Sendai, Japan.,Division of Emergency and Critical Care Medicine, Graduate School of Medicine, Tohoku University, Aoba-ku, Sendai, Japan
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Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE. J Cardiopulm Rehabil Prev 2017; 37:315-321. [PMID: 28787353 DOI: 10.1097/hcr.0000000000000262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.
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Kristiansen AM, Svanholm JR, Schjødt I, Mølgaard Jensen K, Silén C, Karlgren K. Patients with heart failure as co-designers of an educational website: implications for medical education. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:47-58. [PMID: 28237976 PMCID: PMC5346182 DOI: 10.5116/ijme.5898.309e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 02/06/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To identify the learning needs of patients with heart failure between outpatients follow-up visits from their perspective and to ascertain what they emphasize as being important in the design of an educational website for them. METHODS We conducted a two-step qualitative study at Aarhus University Hospital, Denmark. Twenty patients with heart failure participated either in focus group interviews, diary writing, or video-recorded design sessions. Data on learning needs were collected in step 1 and analyses, therefore, helped develop the preliminary prototypes of a website. In step 2, patients worked on the prototypes in video-recorded design sessions, employing a think-aloud method. The interviews were transcribed and a content analysis was performed on the text and video data. RESULTS Patients' learning needs were multifaceted, driven by anxiety, arising from, and often influenced by, such daily situations and contexts as the medical condition, medication, challenges in daily life, and where to get support and how to manage their self-care. They emphasized different ways of adapting the design to the patient group to enable interaction with peers and professionals and specific interface issues. CONCLUSIONS This study provided insights into the different learning needs of patients with heart failure, how managing daily situations is the starting point for these needs and how emotions play a part in patients' learning. Moreover, it showed how patient co-designers proved to be useful for understanding how to design a website that supports patients' learning: insights, which may become important in designing online learning tools for patients.
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Affiliation(s)
| | | | - Inge Schjødt
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Charlotte Silén
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Klas Karlgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
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Chiem AT, Chan CH, Ander DS, Kobylivker AN, Manson WC. Comparison of expert and novice sonographers' performance in focused lung ultrasonography in dyspnea (FLUID) to diagnose patients with acute heart failure syndrome. Acad Emerg Med 2015; 22:564-73. [PMID: 25903470 DOI: 10.1111/acem.12651] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/03/2014] [Accepted: 11/07/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The goal of this study was to examine the ability of emergency physicians who are not experts in emergency ultrasound (US) to perform lung ultrasonography and to identify B-lines. The hypothesis was that novice sonographers are able to perform lung US and identify B-lines after a brief intervention. In addition, the authors examined the diagnostic accuracy of B-lines in undifferentiated dyspneic patients for the diagnosis of acute heart failure syndrome (AHFS), using an eight-lung-zone technique as well as an abbreviated two-lung-zone technique. METHODS This was a prospective, cross-sectional study of patients who presented to the emergency department (ED) with acute dyspnea from May 2009 to June 2010. Emergency medicine (EM) resident physicians, who received a 30-minute training course in thoracic US examinations, performed lung ultrasonography on patients presenting to the ED with undifferentiated dyspnea. They attempted to identify the presence or absence of sonographic B-lines in eight lung fields based on their bedside US examinations. An emergency US expert blinded to the diagnosis and patient presentation, as well as to the residents' interpretations of presence of B-lines, served as the criterion standard. A secondary outcome determined the accuracy of B-lines, using both an eight-lung-zone and a two-lung-zone technique, for predicting pulmonary edema from AHFS in patients presenting with undifferentiated dyspnea. Two expert reviewers who were blinded to the US results determined the clinical diagnosis of AHFS. RESULTS A cohort of 66 EM resident physicians performed lung US on 380 patients with a range of 1 to 28 examinations, a mean of 5.8 examinations, and a median of three examinations performed per resident. Compared to expert interpretation, lung US to detect B-lines by inexperienced sonographers achieved the following test characteristics: sensitivity 85%, specificity 84%, positive likelihood ratio (+LR) 5.2, negative likelihood ratio (-LR) 0.2, positive predictive value (PPV) 64%, and negative predictive value (NPV) 94%. Regarding the secondary outcome, the final diagnosis was AHFS in 35% of patients (134 of 380). For novice sonographers, one positive lung zone (i.e., anything positive) had a sensitivity of 87%, a specificity of 49%, a +LR of 1.7, a -LR of 0.3, a PPV of 50%, and an NPV of 88% for predicting AHFS. When all eight lung zones were determined positive (i.e., totally positive) by novice sonographers, the sensitivity was 19%, specificity was 97%, +LR was 5.7, -LR was 0.8, PPV was 76%, and NPV was 68% for predicting AHFS. The areas under the curve for novice and expert sonographers were 0.77 (95% CI = 0.72 to 0.82) and 0.76 (95% CI = 0.71 to 0.82), respectively. CONCLUSIONS Novice sonographers can identify sonographic B-lines with similar accuracy compared to an expert sonographer. Lung US has fair predictive value for pulmonary edema from acute heart failure in the hands of both novice and expert sonographers.
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Affiliation(s)
- Alan T. Chiem
- Department of Emergency Medicine; Olive View-University of California, Los Angeles; Sylmar CA
| | - Connie H. Chan
- Department of Emergency Medicine; Kaiser Permanente Honolulu Medical Center; Honolulu HI
| | - Douglas S. Ander
- Department of Emergency Medicine; Emory University School of Medicine; Atlanta GA
| | | | - William C. Manson
- Department of Anesthesiology; The University of Texas, Southwestern; Dallas TX
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Practice Guidelines for the Diagnosis and Management of Systolic Heart
Failure in Low- and Middle-Income Countries. Glob Heart 2013; 8:141-70. [DOI: 10.1016/j.gheart.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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